Distal Gastrectomy for Symptomatic Stage IV Gastric Cancer Contributes to Prognosis with Acceptable Safety Compared to Gastrojejunostomy

Nobuaki Fujikuni; Kazuaki Tanabe; Minoru Hattori; Yuji Yamamoto; Hirofumi Tazawa; Kazuhiro Toyota; Noriaki Tokumoto; Ryuichi Hotta; Senichiro Yanagawa; Yoshihiro Saeki; Yoichi Sugiyama; Masahiro Ikeda; Masayuki Shishida; Toshikatsu Fukuda; Keisuke Okano; Masahiro Nishihara; Hideki Ohdan; On Behalf Of Hiroshima Surgical Study Group Of Clinical Oncology HiSCO

doi:10.3390/cancers14020388

Distal Gastrectomy for Symptomatic Stage IV Gastric Cancer Contributes to Prognosis with Acceptable Safety Compared to Gastrojejunostomy

Cancers (Basel). 2022 Jan 13;14(2):388. doi: 10.3390/cancers14020388.

Authors

Nobuaki Fujikuni¹, Kazuaki Tanabe², Minoru Hattori³, Yuji Yamamoto⁴, Hirofumi Tazawa⁵, Kazuhiro Toyota⁶, Noriaki Tokumoto⁷, Ryuichi Hotta⁸, Senichiro Yanagawa¹, Yoshihiro Saeki⁹, Yoichi Sugiyama¹⁰, Masahiro Ikeda¹¹, Masayuki Shishida¹², Toshikatsu Fukuda¹³, Keisuke Okano¹⁴, Masahiro Nishihara¹⁵, Hideki Ohdan⁹, On Behalf Of Hiroshima Surgical Study Group Of Clinical Oncology HiSCO

Affiliations

¹ Department of Surgery, JA Onomichi General Hospital, Onomichi 7228508, Japan.
² Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 7398511, Japan.
³ Center for Medical Education Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima 7398511, Japan.
⁴ Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima 7340004, Japan.
⁵ Department of Surgery, Kure Medical Center/Chugoku Cancer Center, Kure 7370023, Japan.
⁶ Department of Surgery, Hiroshima Memorial Hospital, Hiroshima 7300802, Japan.
⁷ Department of Gastroenterological Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima 7308518, Japan.
⁸ Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima 7390041, Japan.
⁹ Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 7398511, Japan.
¹⁰ Department of Surgery, JA Hiroshima General Hospital, Hatsukaichi 7388503, Japan.
¹¹ Department of Surgery, Chuden Hospital, Hiroshima 7308562, Japan.
¹² Department of Surgery, JR Hiroshima Hospital, Hiroshima 7320057, Japan.
¹³ Department of Surgery, Chugoku Rosai Hospital, Kure 7370193, Japan.
¹⁴ Department of Surgery, Miyoshi Central Hospital, Miyoshi 7288502, Japan.
¹⁵ Department of Surgery, Tsuchiya General Hospital, Hiroshima 7300811, Japan.

Abstract

Background: The prognostic prolongation effect of reduction surgery for asymptomatic stage IV gastric cancer (GC) is unfavorable; however, its prognostic effect for symptomatic stage IV GC remains unclear. We aimed to compare the prognosis of gastrectomy and gastrojejunostomy for symptomatic stage IV GC.

Methods: This multicenter retrospective study analyzed record-based data of patients undergoing palliative surgery for symptomatic stage IV GC in the middle or lower-third regions between January 2015 and December 2019. Patients were divided into distal gastrectomy and gastrojejunostomy groups. We compared clinicopathological features and outcomes after propensity score matching (PSM).

Results: Among the 126 patients studied, 46 and 80 underwent distal gastrectomy and gastrojejunostomy, respectively. There was no difference in postoperative complications between the groups. Regarding prognostic factors, surgical procedures and postoperative chemotherapy were significantly different in multivariate analysis. Each group was further subdivided into groups with and without postoperative chemotherapy. After PSM, the data of 21 well-matched patients with postoperative chemotherapy and 8 without postoperative chemotherapy were evaluated. Overall survival was significantly longer in the distal gastrectomy group (p = 0.007 [group with postoperative chemotherapy], p = 0.02 [group without postoperative chemotherapy]).

Conclusions: Distal gastrectomy for symptomatic stage IV GC contributes to prognosis with acceptable safety compared to gastrojejunostomy.

Keywords: distal gastrectomy; gastric cancer; gastrojejunostomy; palliative surgery; stage IV.